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Thread: insurance denied coverage of DME

  1. #1

    insurance denied coverage of DME

    Greetings,

    I'm sure everyone has been down this road before and now I have the pleasure of traveling it for a while...

    I won't bore you with details but does anyone have a good template/form letter for a letter of appeal to an insurance company?

    Thanks,

    -dave

    *************************************************************
    *** c4/c5 incomplete *** Injured in Summer 2003 ***
    *************************************************************

  2. #2
    Quote Originally Posted by daveh0
    I won't bore you with details but does anyone have a good template/form letter for a letter of appeal to an insurance company?
    Dave,
    Your best best is probably to get the company (or OT) that is providing ypou with the DME to write the appeal. In most cases the appeal still has to come from you, but they should have more experience in this. Have them write it and then you should still review it. I would send it by certified mail to make a statement and be sure it doesn't get "lost."
    My opinion,
    Carl

  3. #3
    Senior Member
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    I sent you a private message Dave. Let me know if I can help in any way.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  4. #4
    Senior Member
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    Daveho

    I had some experience earlier this year about appealing a decision by Blue Shield of California when they denied a $17,000 claim for transportation from Phoenix to Atlanta. I filed the claim 9 times and then our case worker at the Shepherd Center wrote a powerful letter. After all of that the same person who originally denied the claim authorized payment. My message to you is, don't give up and follow the medical insurance procedures exactly. Don't take any short cuts and don't let them take any short cuts. Don't file a grievance until you know in writing why the claim is being denied.

    Roger
    Last edited by Roger; 11-25-2007 at 01:20 AM.

  5. #5
    Have you compared the denial to your copy of your policy? Some insurances specifically exclude DME. I know this is true of a lot of Kaiser policies in CA.

    (KLD)

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